Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000020.xml
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2023; 83(01): 79-87
DOI: 10.1055/a-1799-2658
DOI: 10.1055/a-1799-2658
GebFra Science
Review
Surgical Treatment of Deep Endometriosis
Article in several languages: English | deutsch
Abstract
In deep endometriosis (DE), clusters of endometrium-like cells penetrate more than 5 mm below the peritoneum: The affected organs and tissue structures can eventuate in an alteration of the anatomy with eliminated organ boundaries, which in some cases can pose a real surgical challenge, even for experienced surgeons. A comprehensive description of the different manifestations of the disease can be found in the #Enzian classification. Since the operation is usually the foundation for the successful treatment of DE, what is important are conclusive indications, appropriate preoperative preparation and, above all, appropriate experience on the part of the surgical team. This article aims to provide a review of the surgical options that are currently available.
Publication History
Received: 10 July 2022
Accepted after revision: 08 November 2022
Article published online:
11 January 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68: 585-596 DOI: 10.1016/s0015-0282(97)00191-x. (PMID: 31623724)
- 2 Keckstein J, Becker CM, Canis M. et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020; 2020: hoaa002 DOI: 10.1093/hropen/hoaa002. (PMID: 32064361)
- 3 Wang Y, Nicholes K, Shih IM. The Origin and Pathogenesis of Endometriosis. Annu Rev Pathol 2020; 15: 71-95 DOI: 10.1146/annurev-pathmechdis-012419-032654. (PMID: 31479615)
- 4 Koninckx PR, Fernandes R, Ussia A. et al. Pathogenesis Based Diagnosis and Treatment of Endometriosis. Front Endocrinol (Lausanne) 2021; 12: 745548 DOI: 10.3389/fendo.2021.745548. (PMID: 34899597)
- 5 Koninckx PR, Ussia A, Adamyan L. et al. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril 2012; 98: 564-571 DOI: 10.1016/j.fertnstert.2012.07.1061. (PMID: 22938769)
- 6 Jacobson TZ, Duffy JM, Barlow D. et al. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 2009; (04) CD001300 DOI: 10.1002/14651858.CD001300.pub2. (PMID: 19821276)
- 7 Gruber TM, Mechsner S. Pathogenesis of Endometriosis: The Origin of Pain and Subfertility. Cells 2021; 10: 1381 DOI: 10.3390/cells10061381. (PMID: 34205040)
- 8 Kiesel L, Sourouni M. Diagnosis of endometriosis in the 21st century. Climacteric 2019; 22: 296-302 DOI: 10.1080/13697137.2019.1578743. (PMID: 30905186)
- 9 Hudelist G, Fritzer N, Thomas A. et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012; 27: 3412-3416 DOI: 10.1093/humrep/des316. (PMID: 22990516)
- 10 Exacoustos C, Lauriola I, Lazzeri L. et al. Complications during pregnancy and delivery in women with untreated rectovaginal deep infiltrating endometriosis. Fertil Steril 2016; 106: 1129-1135.e1 DOI: 10.1016/j.fertnstert.2016.06.024. (PMID: 27445198)
- 11 Matias-Guiu X, Stewart CJR. Endometriosis-associated ovarian neoplasia. Pathology 2018; 50: 190-204 DOI: 10.1016/j.pathol.2017.10.006. (PMID: 29241974)
- 12 Ulrich UA, Schmidt D. Endometriosis-Associated malignant Neoplasms. In: Mettler L, Alkatout I, Keckstein J, Meinhold-Heerlein I. Endometriosis – A concise practical Guide to current Diagnosis and Treatment. Tuttlingen: Endo Press; 2017: 367-373
- 13 Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997; 67: 817-821 DOI: 10.1016/s0015-0282(97)81391-x. (PMID: 9130884)
- 14 Tuttlies F, Keckstein J, Ulrich U. et al. ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol 2005; 127: 275-281 DOI: 10.1055/s-2005-836904. (PMID: 16195969)
- 15 Keckstein J, Saridogan E, Ulrich UA. et al. The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 2021; 100: 1165-1175 DOI: 10.1111/aogs.14099. (PMID: 33483970)
- 16 Zeppernick F, Zeppernick M, Janschek E. et al. QS ENDO Real – A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland. Geburtshilfe Frauenheilkd 2020; 80: 179-189 DOI: 10.1055/a-1068-9260. (PMID: 32109970)
- 17 Montanari E, Dauser B, Keckstein J. et al. Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis. Reprod Biomed Online 2019; 39: 845-851 DOI: 10.1016/j.rbmo.2019.06.006. (PMID: 31378689)
- 18 Di Giovanni A, Montanari E, Hudelist G. et al. Comparison Between Sonography-Based and Surgical Evaluation of Endometriotic Lesions Using the #Enzian Classification – A Retrospective Data Analysis. Ultraschall Med 2022; DOI: 10.1055/a-1713-3573.
- 19 Montanari E, Bokor A, Szabó G. et al. Accuracy of sonography for non-invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study. Ultrasound Obstet Gynecol 2022; 59: 385-391 DOI: 10.1002/uog.24833. (PMID: 34919760)
- 20 Fendal Tunca A, Iliman DE, Akdogan Gemici A. et al. Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis. Arch Gynecol Obstet 2022; DOI: 10.1007/s00404-022-06451-1.
- 21 Montanari E, Keckstein J, Hudelist G. Pain symptoms and disease extent in deep infiltrating endometriosis (DIE): how to score: rASRM, ENZIAN?. Glob Reprod Health 2020; 5: e37 DOI: 10.1097/GRH.0000000000000037.
- 22 Thomassin-Naggara I, Lamrabet S, Crestani A. et al. Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management. Hum Reprod 2020; 35: 1589-1600 DOI: 10.1093/humrep/deaa103. (PMID: 32619220)
- 23 Poupon C, Owen C, Arfi A. et al. Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement. Eur J Obstet Gynecol Reprod Biol X 2019; 3: 100028 DOI: 10.1016/j.eurox.2019.100028. (PMID: 31403118)
- 24 Imboden S, Bollinger Y, Harma K. et al. Predictive factors for voiding dysfunction after surgery for deep infiltrating endometriosis. J Minim Invasive Gynecol 2021; 28: 1544-1551 DOI: 10.1016/j.jmig.2021.01.009. (PMID: 33476749)
- 25 Hudelist G, Valentin L, Saridogan E. et al. What to choose and why to use-a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis. Facts Views Vision Obgyn 2021; 13: 331-338 DOI: 10.52054/FVVO.13.4.041.
- 26 Hudelist G, English J, Thomas AE. et al. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2011; 37: 257-263 DOI: 10.1002/uog.8858. (PMID: 20954166)
- 27 Venkatesh S, Anjali M, Vasudeva A. et al. Sliding Sign and Gel Sonovaginography: A Sneak Peek Prior to Laparoscopy in Patients with Endometriosis. J Hum Reprod Sci 2020; 13: 26-30 DOI: 10.4103/jhrs.JHRS_169_19. (PMID: 32577065)
- 28 Guerriero S, Condous G, van den Bosch T. et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318-332 DOI: 10.1002/uog.15955. (PMID: 27349699)
- 29 Becker CM, Bokor A, Heikinheimo O. et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022; 2022: hoac009 DOI: 10.1093/hropen/hoac009. (PMID: 35350465)
- 30 Burghaus S, Schäfer SD, Beckmann MW. et al. Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020). Geburtshilfe Frauenheilkd 2021; 81: 422-446 DOI: 10.1055/a-1380-3693. (PMID: 33867562)
- 31 Djokovic D, Pinto P, van Herendael BJ. et al. Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gyn R B 2021; 263: 252-260 DOI: 10.1016/j.ejogrb.2021.06.035. (PMID: 34242934)
- 32 Manganaro L, Celli V, Dolciami M. et al. Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?. Int J Environment Res Publ Health 2021; 18: 9949 DOI: 10.3390/ijerph18199949. (PMID: 34639248)
- 33 Donnez O. Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases. J Clin Med 2021; 10: 5183 DOI: 10.3390/jcm10215183. (PMID: 34768704)
- 34 Abrão MS, Petraglia F, Falcone T. et al. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21: 329-339 DOI: 10.1093/humupd/dmv003. (PMID: 25618908)
- 35 Possover M. Pathophysiologic explanation for bladder retention in patients after laparoscopic surgery for deeply infiltrating rectovaginal and/or parametric endometriosis. Fertil Steril 2014; 101: 754-758 DOI: 10.1016/j.fertnstert.2013.12.019. (PMID: 24424366)
- 36 Fernandes LF, Bassi MA, Abrão MS. Surgical Principles for Disc Resection of Deep Bowel Endometriosis. J Minim Invasive Gynecol 2020; 27: 262 DOI: 10.1016/j.jmig.2019.07.021. (PMID: 31376585)
- 37 Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011; (09) CD001544 DOI: 10.1002/14651858.CD001544.pub4. (PMID: 21901677)
- 38 Dhanawat J, Pape J, Freytag D. et al. Ovariopexy–Before and after Endometriosis Surgery. Biomedicines 2020; 8: 533 DOI: 10.3390/biomedicines8120533. (PMID: 33255531)
- 39 Angioni S, Pontis A, Dessole M. et al. Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery. Arch Gynecol Obstet 2015; 291: 363-370 DOI: 10.1007/s00404-014-3411-5. (PMID: 25151027)
- 40 Roman H, Bridoux V, Merlot B. et al. Risk of bowel fistula following surgical management of deep endometriosis of the rectosigmoid: a series of 1102 cases. Hum Reprod 2020; 35: 1601-1611 DOI: 10.1093/humrep/deaa131. (PMID: 32619233)
- 41 Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection?. Fertil Steril 2017; 108: 931-942 DOI: 10.1016/j.fertnstert.2017.09.006. (PMID: 29202966)
- 42 Roman H, Milles M, Vassilieff M. et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol 2016; 215: 762.e1-762.e9 DOI: 10.1016/j.ajog.2016.06.055. (PMID: 27393269)
- 43 Bendifallah S, Puchar A, Vesale E. et al. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28: 453-466 DOI: 10.1016/j.jmig.2020.08.015. (PMID: 32841755)
- 44 Popoutchi P, Marques Junior OW, Averbach P. et al. Surgical techniques for the treatment of rectal endometriosis: systematic review of randomized controlled trials and observational studies. Arq Gastroenterol 2021; 58: 548-559 DOI: 10.1590/s0004-2803.202100000-97. (PMID: 34909864)
- 45 Roman H, Bubenheim M, Huet E. et al. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod 2018; 33: 47-57 DOI: 10.1093/humrep/dex336. (PMID: 29194531)
- 46 Arata R, Takakura Y, Ikeda S. et al. A case of ileus caused by ileal endometriosis with lymph node involvement. Int J Surg Case Rep 2019; 54: 90-94 DOI: 10.1016/j.ijscr.2018.11.066. (PMID: 30562695)
- 47 Popivanov G, Stoyanova D, Fakirova A. et al. Ileus caused by small bowel, ileocaecal and rectal endometriosis misdiagnosed as Crohn’s disease and managed by synchronous ileocaecal and rectal resection. Ann R Coll Surg Engl 2020; 102: e205-e208 DOI: 10.1308/rcsann.2020.0118. (PMID: 32538117)
- 48 Seyer-Hansen M, Egekvist A, Forman A. et al. Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis. Acta Obstet Gynecol Scand 2018; 97: 47-52 DOI: 10.1111/aogs.13253. (PMID: 29080367)
- 49 Berlanda N, Vercellini P, Carmignani L. et al. Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv 2009; 64: 830-842 DOI: 10.1097/OGX.0b013e3181c4bc3a. (PMID: 19939297)
- 50 Knabben L, Imboden S, Fellmann B. et al. Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril 2015; 103: 147-152 DOI: 10.1016/j.fertnstert.2014.09.028. (PMID: 25439849)
- 51 Ulrich UA, Schüller J. Tief infiltrierende Endometriose: Blase. In: Solomayer EF, Juhasz-Böss I. Kursbuch gynäkologische Endoskopie. Stuttgart, New York: Thieme; 2018: 245-247
- 52 Maccagnano C, Pellucchi F, Rocchini L. et al. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature. Urol Int 2013; 91: 1-9 DOI: 10.1159/000345140. (PMID: 23689345)
- 53 Lusuardi L, Hager M, Sieberer M. et al. Laparoscopic treatment of intrinsic endometriosis of the urinary tract and proposal of a treatment scheme for ureteral endometriosis. Urology 2012; 80: 1033-1038 DOI: 10.1016/j.urology.2012.07.036. (PMID: 22999450)
- 54 Barra F, Scala C, Biscaldi E. et al. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2018; 24: 710-730 DOI: 10.1093/humupd/dmy027. (PMID: 30165449)
- 55 Nezhat C, Main J, Paka C. et al. Multidisciplinary treatment for thoracic and abdominopelvic endometriosis. JSLS 2014; 18: e2014.00312 DOI: 10.4293/JSLS.2014.00312. (PMID: 25392636)
- 56 Gil Y, Tulandi T. Diagnosis and Treatment of Catamenial Pneumothorax: A Systematic Review. J Minim Invasive Gynecol 2020; 27: 48-53 DOI: 10.1016/j.jmig.2019.08.005. (PMID: 31401265)
- 57 Buscemi S, Maiorana A, Fazzotta S. et al. Scar endometriosis: not a rare cause for a painful scar. Clin Ter 2021; 172: 129-133 DOI: 10.7417/ct.2021.2299. (PMID: 33763680)